Humans ; Aged ; Lung Diseases ; Pneumonia/drug therapy* ; Adrenal Cortex Hormones/therapeutic use* ; Pulmonary Disease, Chronic Obstructive/drug therapy* ; Administration, Inhalation ; Community-Acquired Infections/drug therapy*

ObjectiveTo observe the clinical efficacy of modified Yigongsan combined with multi-enzyme tablets and bifidobacterium triple live powder on infantile anorexia with spleen-stomach Qi deficiency syndrome. MethodA total of 112 infantile patients anorexia with spleen-stomach Qi deficiency syndrome treated at Hebei Provincial Hospital of Traditional Chinese Medicine from January 2022 to June 2023 were enrolled and divided into a control group and an observation group， with 56 cases in each group， according to a random number table. Children in the control group were treated with multi-enzyme tablets and Bifidobacterium triple live powder， while those in the observation group were treated with modified Yigongsan in addition to the treatment in the control group. During the study， one case dropped out in the control group and two cases dropped out in the observation group. The clinical efficacy of the two groups of children was compared， including changes in traditional Chinese medicine （TCM） syndrome scores （main symptoms， secondary symptoms， tongue， and pulse）， time to restore normal food intake， and increase in body weight. Changes in calcium， iron， zinc levels， hemoglobin， and albumin levels before and after treatment， as well as changes in gastrointestinal hormones such as gastrin and motilin， vasoactive intestinal peptide， somatostatin， neuropeptide Y， orexin， and leptin， were observed. The occurrence of adverse reactions in the two groups of children during the study was also recorded. ResultThe total effective rate of children in the control group after treatment was 85.19% （46/54）， while that in the observation group was 98.15% （53/54） （χ² =5.939， P<0.05）. Compared with the control group， the time for food intake to return to normal in the observation group was shorter， and the increase in body weight was greater （P<0.05）. Compared with the results before treatment， the TCM syndrome scores （main symptoms， secondary symptoms， tongue， and pulse） in both groups of children significantly decreased， while the levels of calcium， iron， zinc， hemoglobin， albumin， gastrin， motilin， neuropeptide Y， and orexin increased， and the levels of vasoactive intestinal peptide， somatostatin， and leptin decreased （P< 0.01）. Compared with the control group after treatment， the improvement in the above indicators in the observation group was more significant （P<0.01）. The incidence of adverse reactions in the two groups of children during the treatment period was similar， and the difference was not statistically significant. ConclusionModified Yigongsan combined with multi-enzyme tablets and Bifidobacterium triple live powder is highly effective in treating infantile anorexia （spleen-stomach Qi deficiency syndrome）. After treatment， symptoms of the children were improved，appetite and food intake increased， gastrointestinal function was improved， body weight increased， and adverse reactions were few， indicating that the treatment was safe and reliable.

Objective To investigate the relationship between serum microRNA(miR)-137 and miR-21 ex-pression and hypertensive retinopathy(HR).Methods A total of 123 hypertensive patients admitted to the hospital from March 2020 to August 2022 were selected as the hypertensive group and divided into HR and non-HR groups according to whether they were concomitant with HR,and another 58 healthy people who un-derwent the physical examination during the same period were selected as the control group.Clinical data of HR patients were collected and serum miR-137 and miR-21 expression was detected by real-time fluorescent quantitative PCR.The influencing factors of concurrent HR in hypertensive patients were analyzed,and receiv-er operating characteristic(ROC)curve was used for analzing predictive value of serum miR-137 and miR-21 expression in hypertensive patients with concurrent HR.Results Serum miR-137 and miR-21 relative expres-sion levels were higher in the hypertensive group than those in the control group(P<0.05).The incidence rate of HR in 123 hypertensive patients was 25.20%(31/123).Multivariate Logistic regression analysis showed that prolonged duration of hypertension and elevated systolic pressure,diastolic pressure,miR-137 rel-ative expression level,and miR-21 relative expression level were independent risk factors for HR in hyperten-sive patients(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum miR-137 combined with miR-21 in predicting HR in hypertensive patients was 0.840,which was greater than 0.735 and 0.732 of the single detection of miR-137 and miR-21(P<0.05).Conclusion High expression of serum miR-137 and miR-21 is closely associated with hypertension complicating HR and may be an auxiliary predictor of HR.

Objective:To investigate the impact of the interval period between biopsy and MR examination on tumor detection and extraprostatic extension (EPE) assessment for prostate cancer (PCa) using multi-parametric MRI (mpMRI).Methods:The study was cross-sectional and retrospectively included 130 patients with PCa who underwent RP and preoperative systematic biopsies followed by mpMRI between January 2021 and December 2022 in the First Medical Center of Chinese PLA General Hospital. Patients were divided into 3 groups according to interval following biopsy (group A,<3 weeks, 31 cases; group B, 3-6 weeks, 67 cases; group C,>6 weeks, 32 cases). The percentages of hemorrhage volume in the total prostate were drawn on T 1WI and calculated. The junior, senior and expert radiologists independently localized the index lesions and calculated the accuracy for tumor detection, in addition to assessing the probabilities of EPE according to EPE grade. The correlation between the hemorrhage extent and interval was analyzed using the Spearman correlation coefficient. The accuracy for tumor detection was compared using χ2 test among groups. The diagnostic performance of the radiologists for EPE prediction was assessed using the receiver operating characteristic curve, and the differences between the corresponding area under the curve (AUC) were compared using the DeLong test. Results:The percentage of hemorrhage was correlated with the interval between biopsy and MR examination ( r=-0.325, P<0.001). The detection accuracy of junior radiologist was 83.9% (26/31), 76.1% (51/67), and 78.1% (25/32) in group A, B and C, respectively; no differences were observed in the detection accuracy among three groups ( χ2=0.76, P=0.685). The detection accuracy of senior radiologist was 83.9% (26/31), 80.6% (54/67), and 71.9% (23/32) in 3 groups with no differences ( χ2=1.53, P=0.464). The detection accuracy of expert radiologist was 80.6% (25/31), 77.6% (52/67), and 93.8% (30/32) with no differences ( χ2=3.95, P=0.139). The AUC (95% CI) for predicting EPE were 0.830 (0.652-0.940), 0.704 (0.580-0.809), 0.800 (0.621-0.920) in the group A, B and C for junior radiologist; 0.876 (0.708-0.966), 0.768 (0.659-0.863), 0.896 (0.736-0.975) for senior radiologist; and 0.866 (0.695-0.961), 0.813 (0.699-0.895), 0.852 (0.682-0.952) for expert radiologist, respectively. No differences were observed among the subgroups in each radiologist ( P>0.05). Conclusion:The interval period does not significantly affect the detection accuracy and EPE assessment of PCa using mpMRI. There is probably no necessity for prolonged intervals following systematic biopsy to preserve the clarity of MRI interpretation for PCa.

Objective:To investigate the effects of different feeding formulas on the feeding and growth and metabolism of premature infants in the early postnatal period.Methods:Eligible premature infants with the gestational age of ≤ 34 weeks hospitalized from March 2023 to March 2024 were selected as per inclusion criteria, excluding those with congenital metabolic diseases, severe congenital heart disease and developmental malformations of digestive tract. According to the feeding formulas within 2 weeks after birth, premature infants were divided into three groups, namely donor human milk (DHM) group, preterm formula (PF) group and extensively hydrolyzed formula (eHF) group. The characteristics of premature infants, perinatal condition, feeding formulas, milk intake on the 7th and 14th day, the time to the daily milk intake of 120ml/kg and 150ml/kg respectively, the time on parenteral nutrition, the length of hospitalization, feeding intolerance, cholestasis, extrauterine growth retardation and biochemical metabolic indexes at 7 days, 14 days and discharge were collected. The differences of feeding and biochemical metabolic parameters were compared across the three groups.Results:A total of 108 cases were enrolled ,of whom 39 were in DHM group, 37 in PF group and 32 in eHF group. There was no significant difference in gestational age, birth weight, head circumference and maternal complications across the three groups. The milk intake in the DHM group was (50.7±29.1) ml/(kg·d) on the 7th day, compared with (34.2±27.3) ml/(kg·d) in PF group ( P=0.031), and (103.1±36.7) ml/(kg·d) on the 14th day, compared with (73.9±39.2) ml/(kg·d) in the PF group. Compared with the PF group, the DHM group reached the daily milk intake of 120 ml/(kg·d) earlier [(18.5±10.4) days vs. (24.1±10.3) days, P=0.020], had shorter duration of parenteral nutrition [(17.9±10.9) days vs. (23.2±11.2) days, P=0.042], and lower incidence of feeding intolerance (28.2% vs. 48.6%). The length of hospitalization in DHM group was shorter than that in PF group [(33.8±15.5) days vs. (37.8±17.6) days], but there was no significant difference ( P>0.05). There was no significant difference between the DHM group and the eHF group in terms of the milk intake on the 7th and 14th day, the time to the daily milk intake of 120 ml/(kg·d), the time on parenteral nutrition, the length of hospitalization and feeding intolerance. At 1 and 2 weeks after birth, alkaline phosphatase in DHM group was higher than that in PF group and eHF group ( P<0.05), but there was no significant difference in biochemical nutritional metabolism parameters (hemoglobin, urea nitrogen, albumin, prealbumin, alkaline phosphatase and total bile acid) across the three groups at discharge( P>0.05). Conclusion:Early use of DHM in premature infants is better tolerated than PF and can help achieve complete enteral nutrition earlier and shorten the use of parenteral nutrition, while not affecting the growth and development of premature infants.

Objective To investigate the relationships of the expression of serum matrix metalloproteinase-9 (MMP-9), soluble urokinase type plasmin activator receptor (suPAR) and plasmin activator inhibitor-1 (PAI-1) with the cardiac function grading and prognosis in elderly patients with chronic heart failure (CHF). Methods A total of 108 CHF patients and 50 healthy individuals with physical examination in the same period in Langfang City Hospital of Traditional Chinese Medicine were respectively selected as study group and control group. The blood samples were collected for detection of serum levels of MMP-9, suPAR and PAI-1. The differences in serum indicators among patients with different cardiac functional grades of the New York Heart Association (NYHA) and different prognoses were compared, and the predictive values of serum indicators for poor prognosis were analyzed as well. Results Compared with the control group, the serum levels of MMP-9, suPAR and PAI-1 in the study group were significantly higher (P < 0.05). The levels of serum MMP-9, suPARand PAI-1 increased gradually and significantly in patients with the increase of NYHA grading as grade Ⅱ, grade Ⅲ and grade Ⅳ (P < 0.05). The results of the one-year follow-up showed that there were 65 cases with good prognosis and 43 cases with poor prognosis, and the poor prognosis rate was 39.81% (43/108). Compared with patients of good prognosis, patients with poor prognosis had higher age, higher incidence of complicated hypertension, lower left ventricular ejection fraction (LVEF), and higher levels of left ventricular end diastolic diameter (LVEDD), MMP-9, suPAR and PAI-1 (P < 0.05). Logistic regression analysis showed that age, MMP-9, suPAR and PAI-1 were the risk factors for poor prognosis in elderly patients with CHF, while LVEF was a protective factor for poor prognosis in elderly patients with CHF (P < 0.05). The area under the curve (AUC) of serum MMP-9, suPAR and PAI-1 detected separately and in combination were 0.711, 0.829, 0.768 and 0.840 respectively, the sensitivity and specificity of the three indexes in combination were 88.21% and 79.46% respectively. Conclusion The expression levels of serum MMP-9, suPAR and PAI-1 in elderly patients with CHF are closely related to thecardiac functional grading and poor prognosis.

Objective To investigate the expression levels of serum insulin-like growth factor binding protein-7 (IGFBP-7) and silence-information regulatory factor 4 (SIRT4) in patients with acute heart failure (AHF) and their prognostic value. Methods A total of 151 patients with AHF (AHF group) and 151 healthy subjects (control group) were enrolled. Serum IGFBP-7, SIRT4, N-terminal natriuretic peptide precursors (NT-proBNP) and reactive oxygen species (ROS) were detected in the two groups. The relationships of serum levels of IGFBP-7, SIRT4, NT-proBNP, ROS with clinical grade were analyzed. Pearson correlation coefficient was used to analyze the correlations of IGFBP-7 and SIRT4 with NT-proBNP and ROS. Multivariate Logistic regression analysis was used to analyze the prognostic factors of AHF patients, and the Receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of serum IGFBP-7 and SIRT4 on poor prognosis of AHF patients. Results Compared with the control group, the expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS in serum of the AHF group were significantly increased (P < 0.05). The expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS in the serum of patients with clinical disease grade Ⅳ were higher than that in grade Ⅲ and grade Ⅱ, and those with grade Ⅲ was significantly higher than that of grade Ⅱ (P < 0.05). The expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS and severity grading in patients with poor prognosis in the AHF group were significantly higher than those in patients with good prognosis (P < 0.05). The expression levels of IGFBP-7 and SIRT4 in serum were positively correlated with the levels of NT-proBNP and ROS (r=0.523, 0.498, 0.578, 0.557, P < 0.05). Multifactor Logistic regression analysis showed that clinical grade, serum expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS were independent influencing factors for prognosis of AHF (P < 0.05). ROC curve analysis showed that serum IGFBP-7 and SIRT4 had a certain predictive value for prognosis in AHF patients, with AUC of 0.794 and 0.795, and the combined detection of IGFBP-7 and SIRT4 had a higher predictive value (AUC was 0.909, 95%CI, 0.858 to 0.959). Conclusion Serum IGFBP-7 and SIRT4 are highly expressed in patients with AHF, and their expression levels are correlated with clinical grade and prognosis, and the combined detection of the two indicators is of high reference value for evaluating the prognosis of patients.

OBJECTIVE: To improve the recognition of Familial glucocorticoid deficiency type 1 (FGD1) due to variants of melanocortin 2 receptor (MC2R) gene. METHODS: Two children with FGD1 diagnosed at the Henan Children's Hospital respectively in 2019 and 2021 were selected as the study subjects. Clinical data, treatment, follow-up and results of genetic testing were collected and retrospectively analyzed. RESULTS: Whole exome sequencing revealed that both children had harbored compound heterozygous variants of the MC2R gene, including c.433C>T (p.R145C) and c.710T>C (p.L237P) in child 1, and c.145delG (p.V49Cfs*35) and c.307G>A (p.D103N) in child 2, among which c.710T>C (p.L237P) and c.145delG (p.V49Cfs*35) were unreported previously. CONCLUSION FGD1 is clinically rare, and genetic sequencing is crucial for the definite diagnosis. Discovery of the and novel variants has enriched the mutational spectrum of the FGD1 gene.
Humans ; Child ; Glucocorticoids/therapeutic use* ; Receptor, Melanocortin, Type 2/genetics* ; Retrospective Studies ; Adrenal Insufficiency/genetics* ; Mutation

Objectives:To investigate the effect of fat suppression (FS) T 2WI on the interobserver agreement and diagnostic performance of clear cell likelihood score version 2.0 (ccLS v2.0) for clear cell renal cell carcinoma (ccRCC). Methods:In this retrospective study, the MR images of 111 patients with pathologically confirmed small renal masses (SRM) from January to December 2021 were analyzed in the First Medical Centre, Chinese PLA General Hospital. Of the 111 SRM, 82 cases were ccRCC and 29 cases were non-ccRCC. Two radiologists independently assessed ccLS scores based on T 2WI signal intensity (hypointense, isointense, hyperintense) and other MRI features (ccLS-T 2WI). After a one-month interval, the ccLS scores were independently evaluated utilizing the frequency-selective saturation FS-T 2WI and other MRI features (ccLS-FS-T 2WI). Fisher′s exact test was used to compare the difference in SRM signal intensity on T 2WI and FS-T 2WI. The weighted Kappa test was performed to assess the interobserver agreement of the two radiologists, and differences in the weighted Kappa coefficients were compared using the Gwet consistency coefficient. Receiver operating characteristic curves were drawn to evaluate the diagnostic performance of ccLS-T 2WI and ccLS-FS-T 2WI in diagnosing ccRCC, and the area under the curve (AUC) was compared utilizing the DeLong test. Results:The signal intensity of 111 SRM on T 2WI and FS-T 2WI had statistically significant difference (χ 2=126.33, P<0.001), consistent in 88 cases (79.3%) and varied in 23 cases (20.7%). The weighted Kappa coefficient of ccLS-T 2WI was 0.57 (95%CI 0.45-0.69) between the two radiologists, and the weighted Kappa coefficient of ccLS-FS-T 2WI was 0.55 (95%CI 0.42-0.67), and the difference was not statistically significant ( t=-0.65, P=0.520). The AUC of ccLS-T 2WI for ccRCC diagnosis was 0.92 (95%CI 0.86-0.97), while the AUC of ccLS-FS-T 2WI for ccRCC diagnosis was 0.91 (95%CI 0.85-0.96), and the difference was not statistically significant ( Z=1.50, P=0.133). Conclusions:The interobserver agreement and diagnostic performance of ccLS v2.0 based on T 2WI and FS-T 2WI sequences for ccRCC are comparable, and FS-T 2WI is applicable for the clinical application of ccLS v2.0.

Objective To investigate the protective effect of artesunate on hypoxic-ischemic brain damage (HIBD) and its mechanism in neonatal rats. Methods 7-day-old neonatal SD rats were randomly divided into sham operation group, model group, artesunate 5 mg/kg group, artesunate 10 mg/kg group, artesunate 20 mg/kg group and dexamethasone 6 mg/kg group, with 18 rats in each group. HIBD models were established in groups except for the sham operation group. The sham operation group only needed to separate the left common carotid artery without ligation and nitrogen-oxygen mixed gas ventilation. Each group was injected with drug intraperitoneally right after surgery and the rats in the sham operation group and the model group were injected with an equal volume of normal saline (once a day for a total of 5 times). One hour after the last injection, the rats in each group were scored for neurological defects. After the rats were sacrificed, the brain water content was measured and the pathological changes of the brain tissues of rats were observed. Terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) was used to detect the neuronal cell apoptosis, and ELISA was applied to detect the levels of IL-1β, IL-6 and TNF-α in brain tissues and peripheral blood of each group of rats. Western blot analysis was adopted to detect the protein expression levels of NLR family pyrin domain containing 3 (NLRP3), apoptosis-associated speck-like protein containing CARD (ASC) and caspase-1 in the rats brain tissues of each group. Results Compared with the model group, the neurological deficit score was decreased; the pathological damage of brain tissues was relieved; the brain water content was significantly reduced; the apoptosis number of hippocampal neurons was decreased significantly; the levels of IL-1β, IL-6 and TNF-α in brain tissues and peripheral blood were significantly reduced; the protein expression levels of NLRP3, ASC and caspase-1 were significantly lowered in the middle-dose and high-dose artesunate groups and the dexamethasone group. Conclusion Artesunate can improve the neurological function, relieve the brain damage, and alleviate the brain edema in neonatal rats with HIBD. It can protect the HIBD, which may be related to the inhibition of NLRP3 inflammasome activation and reduction of inflammatory cytokine secretion.
Animals ; Rats ; Animals, Newborn ; Artesunate/pharmacology* ; Brain/metabolism* ; Caspases/metabolism* ; Dexamethasone ; Hypoxia-Ischemia, Brain/pathology* ; Inflammasomes ; Interleukin-6/metabolism* ; NLR Family, Pyrin Domain-Containing 3 Protein/metabolism* ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha/metabolism* ; Water/metabolism*